SAFETY VALIDATIONS -
Client:______________________________________________________________
Policy #_____________________________________________________________
Safety Consultant:________________________ Telephone # (______) _______________________ Fax: (______)
_____________________
A narrative report, including any recommendations, must be attached explaining Items 1 through 7.
A. SAFETY ADMINISTRATION
B. IDENTIFICATION OF OCCUPATIONAL HAZARDS
C. RECORD-KEEPING
D. EMPLOYEE TRAINING AND EDUCATION
E. AUDITS AND INSPECTIONS
ACCIDENT INVESTIGATIONS.
PROGRAM REVIEW
1. Does this client perform periodic reviews of their safety program and revise the safety program as necessary?
Please rate this client’s commitment to their safety program. Scale: 1 lowest / to 10 Highest
Please rate this client’s safety performance based on the above seven areas of their safety program.
Please indicate (by an “x”) the services you provide to this client:
___Program Review
___Inspections
___Special hazard Surveys
___Developed of Safety Program
___Developed Safety Manual
___Other:
Please rate the exposures of this client as respects: Severity / Catastrophe
(Scale: 1 Low to 10 High) Occupational Disease Cumulative Trauma
Safety Professional: _________________________________________________________ Date: _________________________
GUIDELINES FOR COMPLETING THE SAFETY VALIDATION FORM
The Safety Validation form is intended as a brief evaluation of a safety program. The form is used in conjunction with an Insurance Company’s
Primary (PEI) and Excess (EEI) Employers Indemnity Insurance. The proper completion of the safety validation form should adhere to the
following guidelines. Please note that explanatory comments and recommendations are necessary for the proper completion of the form.
1. Safety administration Is top management committed to the safety program? Is there a written safety policy? Is it signed by top
management? Is there a written safety program? is it signed by top management? Has responsibility for enforcement of the safety program
been clearly assigned? Has authority for enforcement of the safety program been clearly assigned?
2. Identify occupational hazards Are loss trends analyzed? Is the analysis acted upon? Are established rules / policies used to guard against
occupational hazards? Is the loss trend analysis current for all operations / departments / divisions?
3. Keep and file records Are safety meetings documented? Are all state or federal forms or logs posted and / or filed as required? Is the
responsibility for maintaining, filing and retaining state or federal forms or logs clearly assigned in the safety program? Is the location of these
records clearly defined in the safety program?
4. Employee training and education Is there a new employee orientation program? Is there special job training programs? Is there an ongoing
training program? Are all training programs adequately documented? Is responsibility for training programs clearly assigned in the safety
program? Is authority for training programs clearly assigned in the safety program?
5. Self audits / self inspections Is there a formal self inspection program defined in the safety program? Is the responsibility clearly assigned in
the safety program? Is the frequency of the inspections clearly defined and adequate for the operations? Are deficiencies acted upon? Are
inspection results and corrective measures (if any) documented?
6. Accident investigation Are all serious and potentially serious accidents investigated? Is responsibility for investigations clearly assigned? Are
corrective measures taken? Is authority for corrective measures clearly assigned? Are investigations and corrective measures (if any)
documented?
7. Periodic reviews / revisions Is the safety program reviewed at least annually? Is the responsibility for this review clearly assigned? Is top
management involved? Are revisions made to the safety program as required by this review?
Client:______________________________________________________________
Policy #_____________________________________________________________
Safety Consultant:________________________ Telephone # (______) _______________________ Fax: (______)
_____________________
A narrative report, including any recommendations, must be attached explaining Items 1 through 7.
A. SAFETY ADMINISTRATION
- 1. Is safety administration of this client performed adequately?
2. Is the safety program provided in writing?
3. Is the safety program approved of and signed by the top company official?
4. Is the safety program communicated to employees?
5. Are responsibilities assigned?
B. IDENTIFICATION OF OCCUPATIONAL HAZARDS
- 1. Does this client identify occupational hazards adequately?
2. Is there a Trend Analysis?
3. All operations analyzed?
C. RECORD-KEEPING
- 1. Does this client keep and file records as required?
2. OSHA 300 log maintained?
4. Employee Training Records documented & maintained?
4. TEXAS ONLY- (DWC) 5 forms filed?
5. TEXAS ONLY - (DWC)7 forms filed?
D. EMPLOYEE TRAINING AND EDUCATION
- 1. Does this client provide adequate employee training and education?
2. Is employee safety training included as part of the New employee orientation?
3. Is there sustained, ongoing training?
4. Does the client conduct training as may be required Regulatory statutes?
5. Are all training activities documented?
E. AUDITS AND INSPECTIONS
- 1. Does this client conduct and use self audits and self inspections?
2. Are there scheduled inspections?
3. Do all work area and locations get inspected regularly?
4. Are vehicle's inspected and well maintained?
5. Are tools/ equipment and machinery inspected?
ACCIDENT INVESTIGATIONS.
- 1. Does this client conduct adequate accident investigations and follow-up?
2, Is a person designated to conduct accident investigations?
3. Is there an accident reporting form used?
4. Are root causes identified and solutions implemented to minimize future accidents?
5. Are there follow-up procedures?
PROGRAM REVIEW
1. Does this client perform periodic reviews of their safety program and revise the safety program as necessary?
Please rate this client’s commitment to their safety program. Scale: 1 lowest / to 10 Highest
Please rate this client’s safety performance based on the above seven areas of their safety program.
Please indicate (by an “x”) the services you provide to this client:
___Program Review
___Inspections
___Special hazard Surveys
___Developed of Safety Program
___Developed Safety Manual
___Other:
Please rate the exposures of this client as respects: Severity / Catastrophe
(Scale: 1 Low to 10 High) Occupational Disease Cumulative Trauma
Safety Professional: _________________________________________________________ Date: _________________________
GUIDELINES FOR COMPLETING THE SAFETY VALIDATION FORM
The Safety Validation form is intended as a brief evaluation of a safety program. The form is used in conjunction with an Insurance Company’s
Primary (PEI) and Excess (EEI) Employers Indemnity Insurance. The proper completion of the safety validation form should adhere to the
following guidelines. Please note that explanatory comments and recommendations are necessary for the proper completion of the form.
1. Safety administration Is top management committed to the safety program? Is there a written safety policy? Is it signed by top
management? Is there a written safety program? is it signed by top management? Has responsibility for enforcement of the safety program
been clearly assigned? Has authority for enforcement of the safety program been clearly assigned?
2. Identify occupational hazards Are loss trends analyzed? Is the analysis acted upon? Are established rules / policies used to guard against
occupational hazards? Is the loss trend analysis current for all operations / departments / divisions?
3. Keep and file records Are safety meetings documented? Are all state or federal forms or logs posted and / or filed as required? Is the
responsibility for maintaining, filing and retaining state or federal forms or logs clearly assigned in the safety program? Is the location of these
records clearly defined in the safety program?
4. Employee training and education Is there a new employee orientation program? Is there special job training programs? Is there an ongoing
training program? Are all training programs adequately documented? Is responsibility for training programs clearly assigned in the safety
program? Is authority for training programs clearly assigned in the safety program?
5. Self audits / self inspections Is there a formal self inspection program defined in the safety program? Is the responsibility clearly assigned in
the safety program? Is the frequency of the inspections clearly defined and adequate for the operations? Are deficiencies acted upon? Are
inspection results and corrective measures (if any) documented?
6. Accident investigation Are all serious and potentially serious accidents investigated? Is responsibility for investigations clearly assigned? Are
corrective measures taken? Is authority for corrective measures clearly assigned? Are investigations and corrective measures (if any)
documented?
7. Periodic reviews / revisions Is the safety program reviewed at least annually? Is the responsibility for this review clearly assigned? Is top
management involved? Are revisions made to the safety program as required by this review?
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"We are what we repeatedly do. Excellence, then, is not an act, but a habit."
-Aristotle
-Aristotle
| Hazard Analysis Safety Training Inspections Record-keeping Accident Reporting Accident Investigations Safety Management Committment Statement |
| Texas is one of the few States that allows employers to opt out of the workers' compensation program. Texas employers may opt to carry occupational health plan as a benefit for employees who are injured while at work. The tenants of a successful occupational injury benefit program rests with the employer implementing a sound safety management program to prevent occupational accidents and claims. |
SAFETY VALIDATIONS
| The basic elements of a sound safety management program should mirror best practices commonly accepted for the prevention of occupational accidents in all industries. |
| Drug and Alcohol Policies Early Return to Work Programs (ERTW) Claims Management Processes Fraud Identification Factors Supervisory Involvement in Loss Control |
| Binding Arbitration Agreements |
| Effective and Clear Communication Processes |